Adenomyosis Treatment Melbourne

Adenomyosis Treatment Melbourne

What is adenomyosis?

Adenomyosis is a benign (non-cancerous) but often painful condition where the endometrial tissue—normally lining the inside of the uterus—grows into the muscular wall of the uterus (the myometrium). This causes the uterus to become enlarged, often described as bulky or tender, and can lead to a variety of symptoms.

Adenomyosis is a common condition, estimated to affect up to 1 in 3 women, particularly those in their 30s and 40s. It tends to be more frequently diagnosed in women who have had children, although it can also occur in women who haven’t.

How is adenomyosis  different from endometriosis?

Both conditions involve endometrial-like tissue growing outside its normal location, but they differ in where the tissue is found:

• Adenomyosis: the endometrial tissue grows into the muscle wall of the uterus
• Endometriosis: the endometrial tissue grows outside the uterus—on the ovaries, bowel, bladder, or other pelvic organs

It’s possible to have both conditions at the same time, and they may share symptoms such as pelvic pain. However, adenomyosis more commonly causes heavy periods, whereas endometriosis is often associated with pain throughout the cycle and during sex, and may not always cause heavy bleeding.

What symptoms does adenomyosis cause?

Symptoms can vary significantly from person to person. Some women may have no symptoms at all, while others experience debilitating effects. The most common symptoms include:

• Heavy menstrual bleeding  (menorrhagia) – periods that are prolonged, heavy, or require frequent pad/tampon changes
• Severe menstrual pain (dysmenorrhea) – cramping that may worsen over time
• Chronic pelvic pain – discomfort that persists throughout the month
• Pain during intercourse (dyspareunia)
• A sensation of pelvic pressure or fullness due to an enlarged uterus

In some cases, women may also notice fatigue, anaemia from blood loss

How is adenomyosis diagnosed?

Diagnosing adenomyosis can be challenging because its symptoms can overlap with other gynaecological conditions, such as fibroids or endometriosis. Diagnosis may involve:

• Pelvic ultrasound – especially using transvaginal ultrasound, which may show a thickened or heterogeneous myometrium
• MRI (Magnetic Resonance Imaging) – particularly helpful in distinguishing adenomyosis from fibroids or other uterine abnormalities
• Clinical examination – your doctor may feel that the uterus is enlarged or tender

Ultimately, the definitive diagnosis of adenomyosis is made by examining the uterus under a microscope after hysterectomy. This is because imaging and symptoms alone cannot always provide a clear diagnosis.

What treatment options are there for adenomyosis?

Treatment depends on the severity of symptoms, the woman’s age, and whether she wishes to have children in the future. The primary goal of treatment is to manage symptoms—particularly pain and bleeding.

Non-surgical Treatments:

• Hormonal therapies:
  • Combined oral contraceptive pill
  • Progesterone treatments – oral or intrauterine device (e.g. Mirena)
  • GnRH analogues (temporary menopause-like state)

These treatments aim to reduce or suppress menstruation, relieving the most distressing symptoms in many women.

Surgical Treatments:

•  Hysterectomy– surgical removal of the uterus
  • This is currently the only definitive cure for adenomyosis, especially in cases that are severe, do not respond to medical treatment, or significantly impact quality of life.
  • Ovaries are usually preserved if the woman is not yet menopausal, as they are not involved in adenomyosis.

While hysterectomy stops any menstrual bleeding and pain from the adenomyotic uterus, other pain from the pelvis will need to be managed for the longer term especially if there is also presence of endometriosis.

Can Adenomyosis Be Surgically Removed Without Hysterectomy?

Unfortunately, adenomyosis usually infiltrates the uterus diffusely, meaning it spreads throughout the muscle wall without a clear boundary. Unlike fibroids—which are well-defined and can often be removed (myomectomy)—adenomyosis is interwoven with normal uterine muscle.

In some cases, adenomyosis can form a localized mass, known as an adenomyoma, which may look like a fibroid on imaging. However, even these are challenging to remove completely and carry a risk of recurrence and incomplete symptom relief.

How should a hysterectomy be done?

In most cases, a laparoscopic hysterectomy (also called “keyhole surgery”) with or without robotic instruments is the preferred method. This involves small incisions in the abdomen, resulting in:

• Less post-operative pain
• Shorter hospital stay
• Lower risk of bleeding and infection
• Quicker return to normal activities
• Minimal scarring

If you have been advised to have an open abdominal hysterectomy (larger incision), it is reasonable—and recommended—to seek a second opinion, especially from a surgeon trained in minimally invasive techniques.

Who should be performing your laparoscopic hysterectomy?

The best outcomes from laparoscopic hysterectomy occur when the procedure is performed by a specialist gynaecologist with advanced training in minimally invasive surgery or a gynaecological oncologist who are trained in complex pelvic surgery. These specialists are highly experienced in performing difficult cases safely, especially when there is distortion of anatomy, large uterine size, or associated endometriosis.

Kent is available to see his private patients in Epworth Freemasons in East Melbourne and Werribee.

If you’re experiencing heavy periods, pelvic pain, or think you may have adenomyosis, don’t hesitate to reach out. You deserve expert care and personalised advice about your treatment options.